(1) The federal
government allows the state to select optional groups to receive medical
assistance. Pursuant to federal law, any person who is eligible for medical
assistance under the optional groups specified in this section must receive both the
mandatory services specified in sections 25.5-5-102 and 25.5-5-103 and the
optional services specified in sections 25.5-5-202 and 25.5-5-203. Subject to the
availability of federal financial aid funds, the following are the individuals or groups
that Colorado has selected as optional groups to receive medical assistance
pursuant to this article 5 and articles 4 and 6 of this title 25.5:
(a) Individuals who would be eligible for but are not receiving cash
assistance;
(b) Individuals who would be eligible for cash assistance except for their
institutionalized status;
(c) Individuals receiving home- and community-based services as specified in
article 6 of this title;
(d) and (e) Repealed.
(f) Individuals receiving only optional state supplement;
(g) Individuals in institutions who are eligible under a special income level.
Colorado's program for citizens sixty-five years of age or older or physically
disabled or blind, whose gross income does not exceed three hundred percent of
the current federal supplemental security income benefit level, qualifies for federal
funding under this provision.
(h) Persons who are eligible for cash assistance under the works program
pursuant to section 26-2-706, C.R.S.;
(i) Persons who are eligible for the breast and cervical cancer prevention and
treatment program pursuant to section 25.5-5-308;
(j) Individuals who are qualified aliens and were or would have been eligible
for supplemental security income as a result of a disability but are not eligible for
such supplemental security income as a result of the passage of the federal
Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Public
Law 104-193;
(k) Other qualified aliens who entered or were present in the United States
before August 22, 1996;
(l) Children for whom subsidized adoption assistance payments are made by
the state pursuant to article 7 of title 26, C.R.S., or foster care maintenance
payments are made by the state pursuant to article 5 of title 26, C.R.S., but who do
not meet the requirements of Title IV-E of the Social Security Act, as amended;
(m) Parents and caretaker relatives of children who are eligible for the
medical assistance program whose family income does not exceed one hundred
thirty-three percent of the federal poverty line, adjusted for family size;
(m.5) Pregnant women, whose family income does not exceed one hundred
ninety-five percent of the federal poverty line, adjusted for family size;
(n) Repealed.
(o) (I) Individuals with disabilities who are participating in the medicaid buy-in
program established in part 14 of article 6 of this title.
(II) Notwithstanding the provisions of subsection (1)(o)(I) of this section, if the
money in the healthcare affordability and sustainability hospital provider fee cash
fund established pursuant to section 25.5-4-402.4, together with the
corresponding federal matching funds, is insufficient to fully fund all of the
purposes described in section 25.5-4-402.4 (5)(b), after receiving recommendations
from the Colorado healthcare affordability and sustainability enterprise established
pursuant to section 25.5-4-402.4 (3), for individuals with disabilities who are
participating in the medicaid buy-in program established in part 14 of article 6 of
this title 25.5, the state board by rule adopted pursuant to the provisions of section
25.5-4-402.4 (6)(b)(III) may reduce the medical benefits offered or the percentage
of the federal poverty line to below four hundred fifty percent or may eliminate this
eligibility group.
(III) Repealed.
(p) Subject to federal approval, adults who are childless or without a
dependent child in the home, as described in section 1902 (a)(10)(A)(i)(VIII) of the
social security act, 42 U.S.C. sec. 1396a, who have attained nineteen years of age
but have not attained sixty-five years of age, and whose family income does not
exceed one hundred thirty-three percent of the federal poverty line, adjusted for
family size;
(q) Children who are continuously eligible for twelve months pursuant to
section 25.5-5-204.5;
(r) (I) Persons eligible for a medicaid buy-in program established pursuant to
section 25.5-5-206 whose family income does not exceed a specified percentage of
the federal poverty line, adjusted for family size and as set by the state board by
rule, which percentage shall be not more than four hundred fifty percent.
(II) Notwithstanding the provisions of subsection (1)(r)(I) of this section, if the
money in the healthcare affordability and sustainability hospital provider fee cash
fund established pursuant to section 25.5-4-402.4, together with the
corresponding federal matching funds, is insufficient to fully fund all of the
purposes described in section 25.5-4-402.4 (5)(b), after receiving recommendations
from the Colorado healthcare affordability and sustainability enterprise established
pursuant to section 25.5-4-402.4 (3), for persons eligible for a medicaid buy-in
program established pursuant to section 25.5-5-206, the state board by rule
adopted pursuant to the provisions of section 25.5-4-402.4 (6)(b)(III) may reduce
the medical benefits offered, or the percentage of the federal poverty line, or may
eliminate this eligibility group.
(III) Repealed.
(2) (a) A qualified alien, who entered the United States on or after August 22,
1996, shall not be eligible for benefits under this article and articles 4 and 6 of this
title, except as provided in section 25.5-5-103 (3), for five years after the date of
entry into the United States unless he or she meets the exceptions described in the
federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
Public Law 104-193, as amended. After five years, such qualified alien shall be
eligible for benefits under this article and articles 4 and 6 of this title but shall have
sponsor income and resources deemed to the individual or family under rules
established by the state board of human services pursuant to section 26-2-137,
C.R.S.
(b) Notwithstanding the five-year waiting period established in paragraph (a)
of this subsection (2), but subject to the availability of sufficient appropriations and
the receipt of federal financial participation, the state department may provide
benefits under this article and articles 4 and 6 of this title to a pregnant woman
who is a qualified alien and a child under nineteen years of age who is a qualified
alien so long as such woman or child meets eligibility criteria other than citizenship.
(3) A lawfully residing person who is receiving medicaid nursing facility care
or home- and community-based services on July 1, 1997, must continue to receive
such services as long as the person meets the eligibility requirements other than
citizen status. State general funds may be used to reimburse such care in the event
that federal financial participation is not available.
(4) A pregnant person who is lawfully residing is eligible to receive medical
assistance as long as the individual meets eligibility requirements other than those
related to citizen or immigration status. State general funds may be used to
reimburse such care in the event that federal financial participation is not available.
(4.5) (a) Subject to the receipt of federal financial participation, to the
maximum extent allowed under federal law, a person who was eligible for the
medical assistance program for the sixty days following the pregnancy remains
continuously eligible for all services under the medical assistance program for the
twelve-month postpartum period.
(b) The state department shall seek any plan amendment necessary to
implement a twelve-month postpartum benefit pursuant to this subsection (4.5) and
shall implement the benefit only upon receipt of federal authorization and financial
participation, and no later than July 1, 2022.
(c) If permissible under federal law, an eligible individual within the
postpartum period may resume coverage under the medical assistance program
upon implementation of this section.
(5) An asset test shall not be applied as a condition of eligibility for
individuals or families described in paragraphs (a), (h), and (m.5) of subsection (1) of
this section.
(6) (a) Beginning no later than January 1, 2025, a pregnant person who is not
a citizen and who is not eligible for medical assistance pursuant to subsection (4) of
this section is eligible to receive medical assistance pursuant to this subsection
(6)(a) if the individual meets the eligibility requirements other than those related to
citizenship and immigration status.
(b) A pregnant person who is eligible for medical assistance pursuant to this
subsection (6) remains continuously eligible for all medical services pursuant to the
medical assistance program for the twelve-month postpartum period, so long as
eligibility remains in effect pursuant to subsection (4.5)(a) of this section.
(c) The state department shall seek any necessary federal approvals to
maximize any available federal financial participation in implementing this
subsection (6). Benefits for services obtained pursuant to this subsection (6) must
be provided with only state funds if federal financial participation is unavailable for
such services.
(d) (I) During its 2024 presentation to the joint budget committee of the
general assembly and in its presentation to the health and human services
committee of the senate and the health and insurance committee of the house of
representatives, or any successor committees, at the hearing held pursuant to
section 2-7-203 (2)(a) of the State Measurement for Accountable, Responsive, and
Transparent (SMART) Government Act, the state department shall report on its
plans and progress in implementing the coverage expansion created pursuant to
this subsection (6).
(II) Beginning January 1, 2026, and continuing every January thereafter, the
state department, in its presentation to the joint budget committee of the general
assembly and in its presentation to the health and human services committee of the
senate and the health and insurance committee of the house of representatives, or
any successor committees, at the hearing held pursuant to section 2-7-203 (2)(a) of
the State Measurement for Accountable, Responsive, and Transparent (SMART)
Government Act, shall report on the cost savings and health improvements
associated with the coverage expansion created pursuant to this subsection (6).
(7) and (8) Repealed.
Source: L. 2006: Entire article added with relocations, p. 1858, � 7, effective
July 1. L. 2007: (1)(n) added, p. 897, � 1, effective May 15. L. 2008: (1)(l) and (1)(n)
amended and (1)(o) added, pp. 1532, 2200, �� 1, 2, effective July 1. L. 2009: (1)(m)(I)
and (1)(o) amended and (1)(p), (1)(q), and (1)(r) added, (HB 09-1293, ch. 152, p. 645, �
5, effective July 1; (2) amended, (HB 09-1353), ch. 390, p. 1869, � 2, effective July 1,
2010. L. 2010: (5)(c) added, (HB 10-1043), ch. 92, p. 312, � 2, effective April 15;
(1)(m)(I), (1)(o)(II), (1)(p)(I), (1)(p)(II), (1)(r)(I), and (1)(r)(II) amended, (HB 10-1422), ch. 419,
p. 2111, � 144, effective August 11. L. 2013: (1)(m) and (1)(p) amended, (SB 13-200), ch.
216, p. 898, � 2, effective May 13. L. 2014: (1)(d), (1)(e), and (1)(n) repealed, (1)(m.5)
added, and (5) amended, (SB 14-067), ch. 12, p. 113, � 5, effective February 27. L.
2017: IP(1), (1)(o)(II), and (1)(r)(II) amended, (SB 17-267), ch. 267, p. 1465, � 19,
effective July 1. L. 2021: (4.5) added, (SB 21-194), ch. 434, p. 2871, � 7, effective
September 7. L. 2022: IP(1) and (1)(m.5) amended, (SB 22-052), ch. 43, p. 217, � 3,
effective March 24; (3), (4), and (4.5)(a) amended and (6) added, (HB 22-1289), ch.
399, p. 2842, � 16, effective June 7. L. 2023: (7) and (8) added, (SB 23-182), ch. 118,
p. 430, � 2, effective April 27. L. 2024: IP(7)(a), (7)(b), and (7)(c) amended, (HB 24-1400), ch. 77, p. 261, � 2, effective April 18. L. 2025: (1)(o)(II) and (1)(r)(II) amended,
(SB 25-270), ch. 151, p. 605, � 13, effective May 1.